Despite proponents´ claims, SB 303 allows denial of food and water

Proponents of Senate Bill 303 allege that, under SB 303, artificially-administered nutrition and hydration (i.e. food and water) is required in all cases when the patient or family requests ANH, except in “extreme circumstances.” However, in SB 303, artificially nutrition and hydration ANH can be denied to a patient at the discretion of the physician and hospital in all, not just extreme, cases.

Under Section 7, Section 166.046(e) of SB 303, artificially-administered food and water does not have to be provided—and can be withdrawn—when the ANH will:

(1) hasten the patient's death;
(2) seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment;
(3) result in substantial irremediable physical pain or discomfort not outweighed by the benefit of the provision of the treatment; or
(4) be medically ineffective in prolonging the patient's life.

Several sections of SB 303 set forth the above four criteria as the basis to withhold or deny not only food and water, but also other medical care and treatments. Application and interpretation of these four criteria are left to the hospital administrators and officers who serve on the committee considering the patient’s life or death.

All of these criteria are subjective and empower physicians to base their decisions on their own subjective value judgments, not medical effectiveness. A physician’s opinion about whether nutrition and hydration will “hasten the patient's death” or “be medically ineffective in prolonging the patient's life” is broad and would vary greatly from physician to physician.

Giving the physician and hospital power to dehydrate a patient to death based on a subjective value judgment is an unjust seizure of patient autonomy.

Criteria (2) authorizes a physician, with hospital approval, to deny or remove food and water from a patient if he believes that the provision of ANH would “seriously exacerbate other major medical problems.” While this may seem like a reasonable consideration for the patient or family to make for a loved one, Texas law should not transfer this decision from the patient and his family to physicians and hospitals. The patient should be the one to decide whether and to what degree he wants to live with a disability.

Criteria (3) nullifies patient autonomy and abrogates power to the physician and hospital to make a quality of life, moral, not medical, judgment about the patient’s life. Criteria (3) allows a physician, with hospital approval, to remove food and water from a patient if the hospital committee believes that benefit of the food and water does not outweigh “substantial irremediable physical pain or discomfort.” SB 303 is clearly giving a physician and hospital the authority to decide how much pain or discomfort makes the patient’s life not worth living.

For example, a patient who is suffering from a chronic pain disorder becomes hospitalized (unrelated to his chronic pain) and requires ANH. In this case, providing the nutrition and hydration would be “exacerbating other major medical problems;” simply by feeding the patient, his chronic pain disorder could continue though manageable.

Someone with a chronic pain disorder may refuse ANH— as would be his choice— to direct his own health care decisions. However, if the patient desires food and water, the third criteria under SB 303 would authorize his medical decisions to be unfulfilled. The physician could withhold life-sustaining treatment because the patient will continue to suffer from the serious physical pain caused by the underlying chronic pain disorder.

The same criteria could apply to an otherwise healthy paraplegic who contracts a UTI or pneumonia; treating his UTI and pneumonia could exacerbate other major medical problems by the paralysis continuing its degenerative course.

Patient/surrogates should be able to decide what discomfort and disability they are willing to accept. The ailing and disabled need help in living, not aid in dying. Most physicians would only withhold food and water from a patient when doing so was clinically necessary, but some hospitals will find justification to withhold basic care and treatment under these four criteria in SB 303, hastening the death of patients through dehydration and starvation.